Form Wp1002 - Nomination Of Beneficiaries - National Treasury Page 2

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NOMINATION OF BENEFICIARIES
WP1002
4. Surname
First name
Middle names
%
,
Percentage of benefit
ID No.
Postal address
C
O
D E
Relationship
Date of birth
C
C
Y
Y
M
M D
D
Cell No.
Tel No.
C
O
D E
5. Surname
First name
Middle names
%
,
ID No.
Percentage of benefit
Postal address
C
O
D E
C
C
Y
Y
M
M D
D
Date of birth
Relationship
C
O
D E
Cell No.
Tel No.
6. Surname
First name
Middle names
%
,
ID No.
Percentage of benefit
Postal address
C
O
D E
Relationship
Date of birth
C
C
Y
Y
M
M D
D
Tel No.
C
O
D E
Cell No.
7. Surname
First name
Middle names
%
,
Percentage of benefit
ID No.
Postal address
C
O
D E
C
C
Y
Y
M
M D
D
Date of birth
Relationship
C
O
D E
Cell No.
Tel No.
%
TOTAL
,
VERY IMPORTANT!!!! INVALID IF TOTAL NOT = 100%
ALL PAGES OF THIS FORM MUST BE COMPLETED IN ORDER FOR THIS FORM TO BE VALID AND THE MEMBER AND THE
61779
WITNESSES MUST INITIAL THIS PAGE
Page 2 of 3
Member initial
Witness1
Witness2
Initial
Initial

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